摘要：Recent public health movements have invoked cultural change to improve health and reduce health disparities. We argue that these cultural discourses have sometimes justified and maintained health inequalities when those with power and authority designated their own social practices as legitimate and healthy while labeling the practices of marginalized groups as illegitimate or unhealthy. This “misrecognition,” which creates seemingly objective knowledge without understanding historical and social conditions, sustains unequal power dynamics and obscures the fact that what is deemed legitimate and healthy can be temporally, geographically, and socially relative. We use examples from research across multiple disciplines to illustrate the potential consequences of cultural misrecognition, highlight instances in which culture was invoked in ways that overcame misrecognition, and discuss how cultural reflexivity can be used to improve health research and practice. The past decade of health research has been marked by a growing recognition of the broader social and environmental contexts in which individuals are embedded and how those contexts shape individual risk factors and health behaviors. 1–4 Part of this shift has been a renewed focus on culture, which is an umbrella term used to characterize the values, beliefs, and practices of social groups, most notably among racial minority and other marginalized populations. 5 Cultural assumptions have informed the design and implementation of public health interventions and health care delivery. 6,7 They have also fueled larger social and political movements that seek to alter cultural practices perceived to be unhealthy. First Lady Michelle Obama’s Let’s Move! campaign to increase physical activity and healthy eating, former New York City Mayor Michael Bloomberg’s ban on large sodas, and health insurance mandates in the Affordable Care Act are notable recent examples of campaigns to change cultural practices. In a move that recognizes and capitalizes on this awareness of cultural practices that shape health, the Robert Wood Johnson Foundation, the nation’s largest health philanthropy, recently declared that building “a vibrant American culture of health” is the new centerpiece of their philanthropic priorities directed at reducing health disparities. 8 Movements that invoke culture and cultural change as a means to improve health and reduce health disparities may have laudable goals. In this article, however, we wish to raise awareness about the power dynamics and potential consequences of using culture to understand behavior or to change behavior through policy and practice. The process of crafting and using seemingly objective knowledge without situating it in historical and social conditions is what the French sociologist Bourdieu called “misrecognition.” 9 The practice of misrecognition sustains unequal power relations, because actors have different opportunities to exert their cultural authority, and, in turn, it obscures the fact that what is deemed legitimate and healthy can be temporally, geographically, socially, and culturally relative. Drawing examples from research and practice in sociology, anthropology, public health, and medicine, we argue that discourses of culture can work to justify and maintain health inequalities when actors in positions of power and authority—researchers, politicians, public health advocates, physicians—designate and take for granted their own social practices as legitimate, natural, or healthy while labeling the practices of other groups, particularly those that are marginalized, as illegitimate, unnatural, or unhealthy. In addition to illustrating the consequences of misrecognition, we also present examples of culturally reflexive scholarship that can overcome misrecognition by invoking culture in contextualized and nuanced ways. We argue that such approaches are critical to understanding and ameliorating health disparities. We conclude by discussing how the lens of cultural reflexivity can be used to improve health research and practice.
